Anthropogenic climate change has been called “the biggest global health threat of the 21st century” (Lancet 2009) and is already estimated to cause 100,000 deaths each year internationally.

Today’s medical students – tomorrow’s doctors – will need new skills to respond to the direct and indirect physical effects of climate change in the UK. The direct health effects include flooding due to irregular rainfall (such the floods in 2004 and 2007), heatstroke (responsible for 15,000 excess deaths in France in 2003), new infections such as dengue fever, and changes in atmospheric pollution that exacerbate respiratory conditions.

Indirect effects include drought-induced increases in the price of food which may decrease the nutritional standards of low-income families, increased population density as a result of immigration from areas that become uninhabitable in the EU and abroad, or more frequent wars over scarce natural resources.

International efforts to reduce carbon emissions can also deliver tremendous health benefits. For example, obesity-related illnesses such as diabetes and cardio-vascular disease are increasingly understood to result from ‘obesogenic’ built environments, food production systems and public policies which developed as a result of cheap oil in the 20th century.

Stefi Barna, from the Norwich Medical School at UEA, is leading a national project to introduce teaching about sustainable healthcare into the medical curriculum. The initiative aims to educate medical students to help the NHS reduce carbon emissions and waste, and promote sustainability within the NHS, as part of their duty to protect the health of the public.

She said: “We will need a completely different health care system in the 21st century, and medical students will benefit from a prevention-based, systems-thinking perspective.”

The NHS is the largest public sector emitter of carbon, and its Carbon Reduction Strategy sets stringent goals for an 80 per cent reduction in carbon emissions by 2050.

“To meet this massive reduction, a complete overhaul of how healthcare is provided is necessary”, said Ms Barna.

“This curriculum aims to help doctors contribute to NHS goals, and improve the quality of prevention and treatment by developing management and leadership skills for a world of complexity and uncertainty.”

One of the main challenges is that the NHS carbon footprint must be drastically reduced. Updating heating systems, recycling more, and using less electricity will all help, but that will only account for part of the total.

To reduce the carbon footprint of the health service, doctors can also focus on preventing lifestyle diseases. Pharmaceuticals, for example, are energy-intensive to produce.

“Prescribing medicines that patients don’t take increases the carbon footprint of the NHS. On the other hand, better illness prevention reduces carbon emissions, reduces health inequalities, and ensures a better quality of life for the population.”

“We are considering whether, as part of their duty to protect the health of the public, doctors should advocate carbon reduction policies which can deliver health benefits. The decarbonisation of the NHS can benefit the public’s health on many levels.”

Rather than adding to the heavy curricular load in medical schools, teaching on low-carbon healthcare can be integrated across the curriculum.

“Medical students already study the physiological systems and social systems that determine health and illness. We propose to extend that understanding to include the environmental systems and feedback loops within which all human life – indeed all life – is nested.”

The Sustainable Healthcare Education network is made up of 12 medical schools, and led by UEA, the Campaign for Greener Healthcare and the NHS Sustainable Development Unit.

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